Mateo Fuentes

CLM-2026-9063, Cigna, X-Ray Lumbar Spine, 4+ Views (72110)

In reviewWith you Denied claims

Billed

$1,429

denied Jul 12

Denial risk

55%

winnable with the right notes

Appeal window

41d

closes Oct 10

Appeals

none filed yet

What I did

and what comes next

Claim reached Heron
Posted from the 835 remittance
Jul 12
Denied by Cigna
Not Covered (96)
Jul 12
Heron scored it: 55% denial risk
3 factors found, appeal path chosen
Jul 12
Appeal window closes
41 days left to file
Oct 10

The denial

Not Covered, code 96

Patient: Mateo Fuentes, born 1999-02-05
Payer: Cigna
Procedure: X-Ray Lumbar Spine, 4+ Views (72110)
Diagnosis: M54.51
Denied on: Jul 12, 2026
Assigned to: Heron

Heron says

Service is excluded under the member's current Cigna benefit plan. Verify benefits as of the date of service, plan may have changed mid-year. If non-covered is confirmed, route to patient responsibility rather than appeal.

No appeal yet

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What I sent

Nothing sent yet.

Everything I know about Mateo

across every queue

Everything for this patient

Open exposure

$17,601

Recovered

$310

4 denied claims3 prior auths4 underpayments4 backlog claims

AUTH-4019

70553 · MRI Brain w/ and w/o Contrast

72148 · MRI Lumbar Spine w/o Contrast

72148 · 9d outstanding

70553 · MRI Brain w/ and w/o Contrast

70553 · Pre-Auth Missing

73721 · 20d outstanding

70553 · Duplicate Claim

93306 · Medical Necessity

70553 · 38d outstanding

72148 · 64d outstanding

73630 · underpaid 22.6%

72148 · underpaid 12.8%

71046 · underpaid 31.2%

73630 · underpaid 10.7%

$70 short

Recovered

Nov 24